22. European Stroke Conference 352 Management and economics Health related quality of life associated with carotid artery stenting versus endarterectomy in patients with symptomatic carotid stenosis randomised in the International Carotid Stenting Study (ICSS) S. Morris1, N. Patel2, J. Dobson3, R. Featherstone4, M.M. Brown5 On behalf of the ICSS investigators University College London, London, UNITED KINGDOM1, University College London, Lon-don, UNITED KINGDOM2, London School of Hygiene and Tropical Medicine, London, UNITED KINGDOM3, University College London, London, UNITED KINGDOM4, University College Lon-don, London, UNITED KINGDOM5 Background ICSS is a multicentre international randomised controlled trial comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA) for recently symptomatic carotid artery stenosis. The long-term rate of fatal or disabling stroke did not differ between arms, but there was an excess of any stroke in the CAS arm, mostly within 30 days of treatment. There was an excess of myocardial infarction, cranial nerve palsy and major post-operative haematoma after CEA. The long-term im-pact of these events on health related quality of life (HRQL) was uncertain. We therefore compared the HRQL of stenting with endarterectomy using ICSS data collected up to 48 months post randomi-sation. 472 © 2013 S. Karger AG, Basel Scientific Programme Methods HRQL was measured at randomisation and 1, 6, 12, 24, 36 and 48 months post randomisation using the EQ-5D-3L descriptive system (www.euroqol.org), converted to a single summary index using country-specific value sets. EQ-5D scores of one represent full health; scores of zero are equivalent to death; negative scores represent health states worse than death. We computed mean EQ-5D scores at each time point for survivors and investigated differences between groups by regressing EQ-5D scores at each time point against treatment allocation, EQ-5D score at randomisation, age, gender and centre. Analysis was by intention-to-treat. Results Data were available for 643 of 855 patients allocated CAS and 634 of 858 allocated CEA. There were no significant differences in mean EQ-5D scores between the two groups at any time point ex-cept at month 48, where higher EQ-5D scores were observed for CAS patients (Table 1). Adjusted analyses also showed non-significant differences, except at 12 months where EQ-5D scores were higher for CAS patients (ME 0.032, 95% CI 0.004 to 0.060; Table 2). Conclusion Quality of life is similar in patients with symptomatic carotid stenosis after carotid artery stenting compared with endarterectomy, despite differences in rates of non-disabling outcome events. Table 1. Mean EQ-5D scores (unadjusted) Patients randomised to CAS Patients randomised to CEA P-value Ob-serva-tions Mean (95% CI) Ob-serva-tions Mean (95% CI) Rando-misati-on 612 0.764 (0.746 to 0.782) 634 0.745 (0.726 to 0.765) 0.166 Month 1 643 0.777 (0.757 to 0.797) 627 0.779 (0.760 to 0.798) 0.888 Month 6 633 0.779 (0.759 to 0.799) 634 0.774 (0.755 to 0.793) 0.706 Month 12 625 0.776 (0.756 to 0.796) 630 0.760 (0.740 to 0.780) 0.265 Month 24 594 0.784 (0.765 to 0.802) 592 0.759 (0.737 to 0.780) 0.080 Month 36 550 0.772 (0.751 to 0.792) 545 0.747 (0.724 to 0.770) 0.116 Month 48 419 0.770 (0.746 to 0.793) 410 0.728 (0.701 to 0.755) 0.021 CAS = carotid artery stenting. CEA = carotid endarterectomy. Table 2. Differences in mean EQ-5D scores adjusted for EQ-5D scores at randomisation, age, gender and centre (Patients randomised to CAS minus Patients randomised to CEA) Marginal ef-fect P-value (95% CI) Month 1 -0.009 0.500 (-0.035 to 0.017) Month 6 0.006 0.653 (-0.021 to 0.033) Month 12 0.032 0.026 (0.004 to 0.060) Month 24 0.017 0.231 (-0.011 to 0.046) Month 36 0.029 0.087 (-0.004 to 0.063) Month 48 0.038 0.051 to 0.077) CAS = carotid artery stenting. CEA = carotid endarterectomy.
Karger_ESC London_2013
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